What prevents us from treating severe asthma well? A doctor’s perspective

Aim:
In order to find out the main problems obstructing biological therapy in Poland, a survey was conducted among allergists or those who are in specialization program in allergology.

Material and methods:
The anonymous survey consisted of 52 questions and focused in particular on topics related to the diagnosis of severe asthma, therapy of severe asthma, including biological treatment, patient education and verification of medical recommendations.

Results:
It was found that 63% of surveyed medical specialists were aware that their patients had 3 or more prescriptions for short-acting β₂-agonists. Generalizing the data to the entire population of allergists in Poland, it can be estimated that approximately 12 129 patients fill prescriptions for 3 or more packages of emergency drugs. 23% of allergists do not recommend biological therapy for all patients who could receive biological therapy according to the guidelines. In everyday practice, 12% of specialists do not initiate biological treatment in patients treated with high doses of inhaled steroids (GINA treatment step 5) whose asthma is uncontrolled (174 doctors do not include these patients in biological treatment, which in general gives 5 916 patients). Estimated data indicate that allergologists do not use biological treatment in approximately 6 935 patients, either because the doctor does not use this therapy at all or because he does not treat all patients with indications for therapy in this way.

Conclusions:
According to respondents, the main reason for problems with the popularization of biological therapy in Poland is the lack of knowledge about the therapy among doctors. In second place is too small number of biological treatment centers for severe asthma in Poland and in third place is inadequate financing of biological therapy. However, the main cause of problems in the implementation of biological treatment is the small number of centers where biological treatment takes place (50%), followed by problems with getting to a biological treatment center (40%), problems with the SMPT system (36%), problems with administrative and IT support for patients (34%) and bad financing of the program (14%).